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Sunday, September 27, 2009

Diarrhea

is the frequent passing of loose or watery stools. Acute diarrhea, which is a common cause of death in developing countries, appears rapidly and may last from five to ten days. Chronic diarrhea lasts much longer and is the second cause of childhood death in the developing world. Diarrhea is sometimes accompanied by abdominal cramps or fever. It may be caused by infection, allergy, or could be a sign of a serious disorder, such as IBD (inflammatory bowel disease), or Crohn's disease. What are the five types of diarrhea?

Secretory diarrhea

Either the gut is secreting more fluids than usual, or it cannot absorb fluids properly. In such cases structural damage is minimal. This is most commonly caused by a cholera toxin - a protein secreted by the bacterium Vibrio cholera.

Osmotic diarrhea

Too much water is drawn into the bowels. This may be the result of celiac disease, pancreatic disease, or laxatives. Too much magnesium, vitamin C, undigested lactose, or undigested fructose can also trigger osmotic diarrhea.

Motility-related diarrhea

Food moves too quickly through the intestines (hypermotility). If the food moves too quickly there is not enough time to absorb sufficient nutrients and water. Patients who had a vagotomy (removal or severing of the vagus nerve) as well as those with diabetic neuropathy are susceptible to this type of diarrhea.

Inflammatory diarrhea

The lining of the gut becomes inflamed. This is usually caused by bacterial infections, viral infections, parasitic infections, or autoimmune problems such as IBS (inflammatory bowel disease). Tuberculosis, colon cancer and enteritis can also cause inflammatory diarrhea.

Dysentery

The presence of blood in the stools is usually a sign of dysentery, rather than diarrhea. Dysentery is caused by a release of excess water caused by an antidiuretic hormone from the posterior pituitary gland. Dysentery is one of the symptoms of Shigella, Entamoeba histolytica, and Salmonella.
When it occurs in people age 60 and older, there's a good possibility bloody diarrhea indicates ischemic colitis, according to the Mayo Clinic, USA.What are the symptoms of diarrhea?

Some sufferers may pass slightly watery stools and have brief episodes of stomachache, while others may pass very watery stools and have more severe stomach cramping. The most common symptoms include:
Abdominal cramps
Abdominal pain
An urge to go to the toilet, sometimes this may be sudden
Vomiting
Nausea
Temperature (fever)
Headache
Loss of appetite
Fatigue
Loose, watery stools
Bloating
Blood in stool
Anybody who has had diarrhea for more than one week should see their doctor. The UK National Health Service advises parents to take their child to the doctor if:
The child is aged 3 months to 1 year and the diarrhea has lasted over two days
The child is over 1 year of age and the diarrhea has lasted more than five days
You should also see your doctor if you experience or witness any of the following:
You have symptoms of dehydration - excessive thirst, very dry mouth, very little or no urination
Your abdominal pain is severe
You have severe rectal pain
There is blood in the stools, the stools are black
Your temperature is over 39C (102 F)
A baby has not wet the diaper (UK: nappy) in over three hours
A child/baby is very sleepy, irritable, or unresponsive
A child/baby has a sunken abdomen
A child/baby has sunken eyes and/or cheeks
The child's/baby's skin does not flatten after being pinchedWhat causes diarrhea?

Causes of acute diarrhea (short term diarrhea)

This is usually caused by an infection, and is also a symptom of a bowel infection when the stomach and the intestines become inflamed (gastroenteritis). This may be caused by:
A virus - most commonly a norovirus or a rotavirus. It could also be caused by a hepatitis virus, or the herpes simplex virus. Viral diarrhea spreads easily.

A bacteria - if food or water is contaminated bacteria and parasites can be transmitted into the body. Parasites may include Giardia lamblia and cryptosporidium. Examples of bacteria are campylobacter, salmonella, shigella and Escherichia coli (E. coli). Traveler's diarrhea is usually caused by bacteria or parasites. Researchers at Boston University School of Medicine identified the structure of bacteria responsible for traveler's diarrhea.

An antibiotic - antibiotics can disturb the natural balance of bacteria in our intestines, which can lead to infection, commonly with a bacterium called Clostridium difficile.
The following may also be causes of acute diarrhea:
Anxiety
Consuming too much alcohol
Consuming too much coffee
Some other medications, apart from antibiotics
Causes of chronic diarrhea (persistent, longer term diarrhea)
Bacteria
A virus
Laxatives
Some dietary habits - long term regular alcohol, coffee consumption may cause persistent diarrhea. Regular eating of candy (sweets) can too. Many sugar-free chewing gums containing a sweetener called sorbitol can cause chronic diarrhea, The British Medical Journal reported.
The following long-term conditions can cause chronic diarrhea
Celiac disease
Crohn's disease
Diabetes
Irritable bowel syndrome (IBS)
Lactose intolerance
Pancreatitis
Ulcerative colitisHow is diarrhea diagnosed?

Most cases of acute diarrhea will resolve themselves within a week or so. If the diarrhea lasts longer, or if there is blood in the stools and there are other symptoms, such as dehydration, the GP (general practitioner, primary care physician) will take a stool sample to check for infection.

A sigmoidoscopy may also be performed. This involves introducing a thin fiber-optic tube through the rectum to look into the intestine. The device has a viewing lens.

The doctor will also ask the patient whether he/she is taking any medications, has traveled recently, and possibly some questions about what foods were consumed over the last couple of weeks. The GP may also examine the abdomen to determine where the pain is.
What is the treatment for diarrhea?

In the vast majority of cases the diarrhea will disappear within a week or so. Before it does, the following steps may help ease symptoms:
Drink plenty of fluids - diarrhea often carries a risk of dehydration, especially if it includes vomiting. It is important to make sure babies and children are getting plenty of fluids.

Diarrhea may affect the balance of salts and electrolytes in the body. Special dehydration drinks can be bought in a pharmacy to restore their balance. A pharmacist can advise on which drinks to consume.

Eat as soon as you feel up to it - doctors used to tell people not to eat until the symptoms went away. They now recommend patients start with foods such as pasta, bread, rice or potatoes - foods high in carbohydrates, as soon as possible. Add a bit of salt to the food to replace salt loss. Avoid foods that are high in fat.

Medications - such medicines as loperamide may slow down bowel movements and may also increase the gut's water absorption. Do not give anti-diarrhea medications to children without checking first with a doctor. Do not take anti-diarrhea medications if there is blood in the stools or if you have a fever.

Breastfeeding or bottle-feeding babies - doctors recommend that feeding continue as normal if the baby has diarrhea. If necessary, add rehydration drinks that are bought from a pharmacy.

Painkillers - for fever or headache doctors recommend Tylenol (paracetamol) or ibuprofen. If you have kidney, liver or long-term stomach problems do not take ibuprofen. Do not give aspirin if your child is under 16 years of age.

Probiotics - these are supposed to treat diarrhea, among other things. However, a study published in the British Medical Journal indicated that some of them don't work, while others do.
Doctors may prescribe specific medications, depending on the results of the stool test.